The practice deals with narrow-specialist analysis of pregnancy and the prevention of complications for both mother and fetus. The aim is also that complications arising in pregnancy do not affect the child’s later development.
Gynaecological care accompanies a woman through all reproductive stages, from childhood to menopause.
A woman’s reproductive life can be divided into several stages. In each of them, gynaecological care has different tasks.
Reproductive life begins in childhood, with the development of female sexual characteristics. A sense of gender, both emotional and spiritual, also develops at this time.
At the first paediatric check-ups, certain congenital anomalies may be noticed.
Puberty brings many psychological and physical changes in girls. In our region it is counted as a period starting between the ages of 12 and 17. A key moment for reproductive health is menarche, the first menstrual period.
Girls should be offered education about reproductive health, hormonal changes, contraception and psychological changes, with support and care.
The reproductive age begins after puberty and lasts until the climacteric. In this period a woman reaches full reproductive maturity.
She should be informed about the option of cervical cancer screening, and offered advice on conception, contraception, sexually transmitted infections and all variations of the menstrual cycle.
The climacteric is the period before and after the last menstrual period. In our region it usually occurs between the ages of 45 and 50, and is marked by the gradual decline of ovarian function.
Women at this age should be informed about the option of breast cancer screening and about the psychological and physical changes that come with the gradual fall in hormones. Healthy habits are particularly important for preventing osteoporosis.
Menopause is the last menstrual period in a woman’s life. Any bleeding after menopause should be examined by a gynaecologist, and regular screening examinations should be continued.
As reproductive hormones are then considerably lower, lubricants and preparations that moisturise and restore the mucous membranes and make intercourse easier can be offered.
Throughout all reproductive stages, the usual physiological changes can be followed. Other topics that affect a woman’s health as a whole are added to this.
In childhood, the girl’s growth is followed. Changes are most pronounced in puberty, when, from the gynaecological side, attention is paid mainly to the development of body hair and breasts and to the onset of menstruation.
Hormones fluctuate through a woman’s reproductive stages and also on a monthly basis, which underlies the menstrual cycle.
The cycle is regulated by hormones whose levels can be measured and may point to a need to supplement or suppress their action. These are the sex hormones (GnRH, LH, FSH, oestrogen, progesterone, testosterone) and the thyroid hormones, above all TSH and fT4.
The musculoskeletal system consists of muscles and bones. Although it is not entirely obvious, bone density, and therefore bone strength, depends on female sex hormones.
In childhood, the girl’s growth and development are followed, while in the climacteric and in senium (older age) it is especially important to pay attention to osteoporosis and to prevent it.
The menstrual cycle begins on the first day of bleeding and ends at the start of the next bleeding. It has two phases, the follicular and the secretory phase.
In the follicular phase, mainly under the influence of oestrogen, follicles containing egg cells grow. The most prominent follicle ruptures and releases an egg cell, a process called ovulation.
The remaining part of the follicle becomes the corpus luteum and secretes progesterone, which regulates the second, secretory phase. During this phase the lining of the uterus thickens so that it can receive a possibly fertilised egg cell, that is, an embryo.
The breasts consist of mammary glands surrounded by fat cells and connective tissue. They begin to develop in puberty and change over a lifetime, through the cycle and in pregnancy.
During life, some of these cells can also undergo malignant transformation. Women are therefore advised to do breast self-examination in the same phase of the cycle, and to have mammographic screening as well.
From puberty, sexual drives develop, both for pleasure and for reproduction. It is especially important to educate girls about consent to sexual intercourse, contraception methods and sexually transmitted infections, and to support them in recognising their own needs.
In older age, because of dryness of the mucosa, it is advisable to use lubricants and preparations that moisturise and regenerate the mucosa of the anogenital tract.
Nutrition in a woman’s life does not differ significantly from general recommendations. It is important to take in an optimal amount of micronutrients and macronutrients, keep body weight under control and prevent complications such as high blood pressure and diabetes.
These conditions can further complicate conception, and later the maintenance of pregnancy, childbirth and the postpartum period.
Sport is important for both physical and mental health. Girls can be encouraged to take up sports from an early age, especially aerobic ones, and it is advisable to continue recreational sport throughout life.
In pregnancy and in older age, light or moderate-intensity exercise such as walking, yoga and gentle swimming is advised. Kegel exercises are particularly important for maintaining the pelvic floor muscles.
The gynaecological aspect of health is only one part of a woman’s overall wellbeing. Many chronic diseases can affect pregnancy planning and pregnancy itself.
It is therefore important to take a multidisciplinary approach and to view health in an integrative and individual way.
The gynaecological examination is the basic part of gynaecological evaluation. It includes inspection of the external genitalia, followed by a bimanual examination and an examination with a speculum.
In normal conditions the examination is not painful, but it can be uncomfortable, so patients are guided, on the advice of the doctor and midwife, into the most suitable position for examining the gynaecological organs.
It is advisable to empty the bladder before the examination so that the findings are as reliable as possible.
Ultrasound is a non-invasive method that produces an image of the internal genital organs. The image is formed by ultrasound waves bouncing from the probe off the organs, and gives a view of different tissue structures. Ultrasound is a subjective method, but it is very important for basic diagnostics.
The examination can be done with a vaginal probe, which is inserted through the vagina (or through the rectum when the former is not available for the first time), or with a transabdominal probe.
Doppler ultrasound is based on the Doppler effect and allows assessment of vascularisation, that is, the blood supply of structures in the small pelvis. It is significant in pregnancy and outside it, as it allows timely detection of various pathological conditions in gynaecology.
Colposcopy is a method in which the cervix is observed under high magnification with a device called a colposcope. The examination takes a few minutes and is not painful.
After a speculum is placed, the colposcope is introduced and the cervix is observed before and after staining with certain solutions. These give insight into the presence of inadequate cells or blood vessels.
Breast ultrasound gives insight into the internal structure of the breasts. It can provide orienting information, which is complemented by the mammography findings.
In addition, certain minor procedures (punctures, biopsies) can be performed under ultrasound guidance, on an outpatient basis and in sterile conditions.
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